Paediatric Physiotherapy

Developmental Disorders -

can include a number of disorders that interrupt or affect a child’s development.  With early intervention, most specific developmental disorders can be accommodated and overcome.

  • Development delay may affect a child's speech and language, fine and gross motor skills, and/or personal and social skills. A child diagnosed with a global delay will have delays in all areas of their development.
  • Developmental Co-ordination disorder (DCD) is a term used to cover many difficulties including, dyspraxia, co-ordination difficulties and clumsiness. Dyspraxia affects the planning of what to do and how to do it. It is associated with problems of perception, language and thought. Dyspraxia is described as having two main elements: difficulty with planning a sequence of coordinated movements and difficulty with executing a plan.
  • Sensory Integration can be as issue for children with DCD, which involves difficulty processing information from their sensory system (sound, touch, vision).
Orthopaedic conditions -

affecting bones and muscles can sometimes be described as musculoskeletal or orthopaedic and can cover many diagnoses.

  • Torticollis (wry neck) is a term used to describe tightness of the sternocleidomastoid muscle in the neck which can limit the range of movement at the neck and in babies can affect their development.
  • Plagiocephaly  is characterised by distortion (flattening) of the developing skull (can be associate with torticollis)
  • Positional talipes (club foot) the ligaments and tendons of the foot and ankle can be tight and cause an altered resting position of the foot after birth.
  • Trauma including sprains, strains and healing post fracture caused by falls and sporting injuries.
  • Osgood Schlatters disease (OSD) is an inflammation of the bone, cartilage, and/or tendon at the top of the shinbone (tibia), where the tendon from the patella attaches. OSD usually affects active adolescents between the ages of 9-16 coinciding with the beginning of their growth spurts.
  • Chondromalacia Patella is the softening and breakdown of the cartilage that lines the underside of the patella and can cause a grinding/grating feeling as the knee moves. It is a common cause of anterior knee pain.
  • Sever’s disease (calcaneal apophysitis), is the most common cause of heel pain in the growing athlete and is due to overuse and repetitive microtrauma of growth plates of the calcaneus (where the Achilles tendon attaches to the heel)
  • Brachial plexus injuries (Erb’s Palsy) the brachial plexi are a group of nerves that conduct messages from the spinal cord to the shoulder, elbow, forearm and hand. These can be injured as a result of shoulder trauma (often associated with childbirth), inflammation or tumours and can result in paralysis, altered sensation and lack of muscle power in the arm.
  • Perthes disease (legg-calve perthes disease) is a degenerative disease of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket. Children can complain of hip pain as well as referred pain into the knee and is usually associated with reduced range of movement and affected walking pattern.
  • Developmental dysplasia of the hip (DDH) describes a variety of conditions in which the ball and socket of the hip do not develop properly and can cause functional difficulties, pain and altered muscle control.
  • Postural Back pain There can be many causes for children complaining of back pain, including poor posture, muscle spasm, lack of adequate core stability. Some children can develop a curvature of the spine (scoliosis and associated with neurological impairments such as CP) which can lead to altered biomechanics, muscle imbalance and pain.
  • Flat feet (pes planus) can be described as when the whole of the foot makes contact with the floor and there is lack of an adequate in step during standing. Flat feet in children can be structural or associated with muscle weakness/joint instability.
Rheumatological conditions -

can cover auto-immune diseases affecting joints, muscles and skin.

  • JIA (Juvenile Idiopathic Arthritis) Children under the age of 16 can develop arthritis in one/multiple joints. A full medical work up is necessary to ensure definite diagnosis, however physiotherapy alongside appropriate medication is paramount in controlling disease progression and avoiding long term joint damage. Children may complain of persistent joint swelling, pain and loss of range of movement, fever/rash.
  • JDM (Juvenile Dermatomyositis) is a disease that primarily affects muscle and skin, but can also have features of joint involvement (as in JIA). There is a distinctive heliotrope (purple/mauve in colour) rash affecting the eyelids and swelling of face, hands (gottrones papules) and knees can be common. Along with this, there is characteristic muscle inflammation causing muscle weakness, and pain within joints and muscles.
  • Joint hypermobility Syndromeis a condition that involves joint laxity and is scored using the ‘Beighton scale’ with a score of 4 out of 9 (joints) being considered hypermobile. Its recognition within the paediatric population has increased over the years and the common musculoskeletal complaints associated with this can be pain, muscle weakness, fatigue.
  • Chronic pain syndromes can be considered an umbrella term for a multitude of pain behaviours, including pain amplification, complex regional pain and neuropathic pain. It is complex in nature and influenced by physical and psychological factors.  Children with this presentation usually require a multidisciplinary management utilising physiotherapy, occupational therapy and psychology services.
Neurological conditions -

the brain and nervous system are extremely complex and allow us to function safely in our environment. Sometimes this complex process can be disturbed and can lead to motor difficulties. Physiotherapy can be utilised to help teach of re teach the brain movement patterns.

  • Cerebral palsy is an umbrella term encompassing a group of non progressive disorders that primarily affects a child’s motor development. The damage to the brain/nervous system can occur before, during or soon after birth.
  • Spina Bifida is a developmental congenital disorder caused by the incomplete development of the spinal cord. Some of the bones that overlay the spinal cord are not fully formed and remain unfused and open. This can affect the function of that nerve and the body part it supplies.
Respiratory conditions/chest physiotherapy -

covers the issues which may arise due to existing pathology affecting the child’s air way and lung fields

  • Cystic fibrosis is a genetic condition which primarily causes the lungs to over produce thick sticky mucus. Physiotherapy (manual techniques, active cycle of breathing and/or autogenic drainage) alongside medication is required to prevent infections and help to keep the lung fields as clear as possible.